Coating of Intestinal Anastomoses for Prevention of Postoperative Leakage: A Systematic Review and Meta-Analysis.
anastomotic leakage (AL)
coated collagen patch
fibrin glue (FG)
fibrin sealant
intestinal anastomoses
Journal
Frontiers in surgery
ISSN: 2296-875X
Titre abrégé: Front Surg
Pays: Switzerland
ID NLM: 101645127
Informations de publication
Date de publication:
2022
2022
Historique:
received:
23
02
2022
accepted:
05
04
2022
entrez:
30
6
2022
pubmed:
1
7
2022
medline:
1
7
2022
Statut:
epublish
Résumé
For several decades, scientific efforts have been taken to develop strategies and medical aids for the reduction of anastomotic complications after intestinal surgery. Still, anastomotic leakage (AL) represents a frequently occurring postoperative complication with serious consequences on health, quality of life, and economic aspects. Approaches using collagen and/or fibrin-based sealants to cover intestinal anastomoses have shown promising effects toward leak reduction; however, they have not reached routine use yet. To assess the effects of covering intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative leakage, a systematic review and meta-analysis were conducted. PubMed, Web of Science, Cochrane Library, and Scopus (01/01/1964 to 17/01/2022) were searched to identify studies investigating the effects of coating any intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative AL, reoperation rates, Clavien-Dindo major complication, mortality, and hospitalization length. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Overall, 15 studies (five randomized controlled trials, three nonrandomized intervention studies, six observational cohort studies) examining 1,387 patients in the intervention group and 2,243 in the control group were included. Using fixed-effects meta-analysis ( The application of collagen-based laminar biomaterials or fibrin sealants on intestinal anastomoses can significantly reduce postoperative rates of AL and its sequelae. Coating of intestinal anastomoses could be a step toward effective and sustainable leak prevention. To assess the validity and robustness of these findings, further clinical studies need to be conducted.
Sections du résumé
Background
UNASSIGNED
For several decades, scientific efforts have been taken to develop strategies and medical aids for the reduction of anastomotic complications after intestinal surgery. Still, anastomotic leakage (AL) represents a frequently occurring postoperative complication with serious consequences on health, quality of life, and economic aspects. Approaches using collagen and/or fibrin-based sealants to cover intestinal anastomoses have shown promising effects toward leak reduction; however, they have not reached routine use yet. To assess the effects of covering intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative leakage, a systematic review and meta-analysis were conducted.
Method
UNASSIGNED
PubMed, Web of Science, Cochrane Library, and Scopus (01/01/1964 to 17/01/2022) were searched to identify studies investigating the effects of coating any intestinal anastomoses with collagen and/or fibrin-based sealants on postoperative AL, reoperation rates, Clavien-Dindo major complication, mortality, and hospitalization length. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
Results
UNASSIGNED
Overall, 15 studies (five randomized controlled trials, three nonrandomized intervention studies, six observational cohort studies) examining 1,387 patients in the intervention group and 2,243 in the control group were included. Using fixed-effects meta-analysis (
Conclusion
UNASSIGNED
The application of collagen-based laminar biomaterials or fibrin sealants on intestinal anastomoses can significantly reduce postoperative rates of AL and its sequelae. Coating of intestinal anastomoses could be a step toward effective and sustainable leak prevention. To assess the validity and robustness of these findings, further clinical studies need to be conducted.
Identifiants
pubmed: 35769150
doi: 10.3389/fsurg.2022.882173
pmc: PMC9235828
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
882173Informations de copyright
Copyright © 2022 Cira, Stocker, Reischl, Obermeier, Friess, Burgkart and Neumann.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
Ann Surg. 2011 May;253(5):890-9
pubmed: 21394013
Am J Surg. 2014 Jun;207(6):840-6
pubmed: 24315377
JAMA Surg. 2013 Jan;148(1):65-71
pubmed: 22986932
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
Surg Technol Int. 2008;17:131-7
pubmed: 18802893
Int J Colorectal Dis. 2012 Oct;27(10):1247-58
pubmed: 22907760
Stat Med. 2002 Jun 15;21(11):1539-58
pubmed: 12111919
Obes Surg. 2003 Feb;13(1):45-8
pubmed: 12630612
Int J Colorectal Dis. 2013 Jan;28(1):119-25
pubmed: 22918661
World J Surg. 2007 Dec;31(12):2412-5
pubmed: 17917772
Ann Surg. 2017 Nov;266(5):839-846
pubmed: 28796016
Zentralbl Chir. 1978;103(20):1325-36
pubmed: 366987
J Gastrointest Cancer. 2007;38(2-4):63-70
pubmed: 19089661
Ann Thorac Surg. 2017 Jan;103(1):267-273
pubmed: 27677565
J Surg Res. 2012 Aug;176(2):e57-63
pubmed: 22445453
Int J Colorectal Dis. 2011 Jun;26(6):729-35
pubmed: 21344301
Int J Colorectal Dis. 2011 Mar;26(3):303-11
pubmed: 21190028
Asian J Surg. 2014 Jan;37(1):35-45
pubmed: 23978425
J Gastrointest Surg. 2014 Jun;18(6):1176-85
pubmed: 24671472
ISRN Surg. 2014 Mar 04;2014:203943
pubmed: 24729902
Microsurgery. 2006;26(3):131-6
pubmed: 16518804
Obes Surg. 2006 Feb;16(2):125-31
pubmed: 16469211
Dig Surg. 2018;35(5):419-426
pubmed: 29131024
Am J Surg. 2010 Apr;199(4):435-41
pubmed: 19481197
J Invest Surg. 2009 Mar-Apr;22(2):138-47
pubmed: 19283617
Eksp Khir Anesteziol. 1971 Mar-Apr;16(2):46-50
pubmed: 4946091
Am J Surg. 2020 Jan;219(1):123-128
pubmed: 31235074
Surg Clin North Am. 1997 Jun;77(3):549-73
pubmed: 9194880
J Gastrointest Surg. 2010 Jan;14(1):104-11
pubmed: 19841989
J Surg Res. 2014 Dec;192(2):375-82
pubmed: 24976442
Cir Esp. 2012 Dec;90(10):647-55
pubmed: 22748849
Eur Surg Res. 2015;54(1-2):1-13
pubmed: 25247310
Ann Surg Oncol. 2021 Oct;28(11):6390-6397
pubmed: 33786677
Syst Rev. 2021 Mar 29;10(1):89
pubmed: 33781348
Obes Surg. 2021 Mar;31(3):1158-1167
pubmed: 33145716
Surg Infect (Larchmt). 2021 Dec;22(10):1047-1051
pubmed: 34255574
Risk Manag Healthc Policy. 2020 Jan 13;13:5-11
pubmed: 32021515
Stat Methods Med Res. 2020 Sep;29(9):2520-2537
pubmed: 32292115
Int J Surg. 2017 Apr;40:163-168
pubmed: 28285057
Langenbecks Arch Surg. 2010 Nov;395(8):1039-48
pubmed: 20680329
BMJ. 2016 Oct 12;355:i4919
pubmed: 27733354
Acta Biomed. 2005 Sep;76(2):95-8
pubmed: 16350554
World J Surg. 2009 May;33(5):986-93
pubmed: 19234736
J Invest Surg. 2016 Dec;29(6):352-358
pubmed: 27191688
Eksp Khir Anesteziol. 1966 Sep-Oct;11(5):21-2
pubmed: 5992944
BMJ. 1997 Sep 13;315(7109):629-34
pubmed: 9310563
Ann Surg. 2014 May;259(5):930-8
pubmed: 24045445
World J Surg. 2014 Oct;38(10):2652-61
pubmed: 24867467
J Cardiothorac Surg. 2020 May 14;15(1):96
pubmed: 32408886
Ann Thorac Surg. 2021 Jul;112(1):255-263
pubmed: 33075324
Ann Surg. 1969 May;169(5):727-35
pubmed: 4888532
Cir Esp. 2017 Dec;95(10):588-593
pubmed: 29117903
Br J Surg. 1996 Jan;83(1):40-1
pubmed: 8653358
Eur J Surg. 2000 Dec;166(12):959-62
pubmed: 11152258
Int Surg. 2014 Jul-Aug;99(4):359-63
pubmed: 25058765
PLoS One. 2018 Mar 22;13(3):e0194249
pubmed: 29566031
Ann Surg. 2017 Nov;266(5):814-821
pubmed: 28796646
Cir Cir. 2016 Mar-Apr;84(2):102-8
pubmed: 26776435
World J Gastrointest Surg. 2016 Sep 27;8(9):627-633
pubmed: 27721926
Ann Surg. 2014 Dec;260(6):1034-9
pubmed: 25072429
J Invest Surg. 2007 Nov-Dec;20(6):363-9
pubmed: 18097878
Langenbecks Arch Surg. 2011 Jun;396(5):685-91
pubmed: 21360273